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1.J. M. Juran, “Early SQC: A historical supplement,” Qual. Prog. 30, 7381 (1997).
2.M. Best and D. Neuhauser, “Walter A Shewhart, 1924, and the Hawthorne factory,” Qual. Saf. Health. Care 15, 142143 (2006).
3.N. R. Tague, The Quality Toolbox, 2nd ed. (ASQ Quality, Milwaukee, WI, 2005).
4.N. R. Mann, Keys to Excellence: The Deming Philosophy (Prestwick House, Clayton, 1989).
5.C. S. Kilian, The World of W. Edwards Deming (SPC, Knoxville, 1992).
6.“If Japan can… why can’t we?”,, 8 January 2007.
7.D. Blumenthal, “Quality of care—What it is?,” N. Engl. J. Med. 335, 891894 (2006).
8.R. H. Brook, E. A. McGlynn, and P. D. Cleary, “Measuring quality of care,” N. Engl. J. Med. 335, 966970 (2006).
9.J. F. Wilson and J. Owen, “Quality research in radiation oncology: A self-improvement initiative 30 years ahead of its time?,” J. Am. Coll. Radiol. 2, 10011007 (2005).
10.T. Kron, C. Hamilton, M. Roff, and J. Denham, “Dosimetric intercomparison for two Australasian clinical trials using an anthropomorphic phantom,” Int. J. Radiat. Oncol., Biol., Phys. 52, 566579 (2002).
11.C. A. Perez, P. Gardner, and G. P. Glasgow, “Radiotherapy quality assurance in clinical trials,” Int. J. Radiat. Oncol., Biol., Phys. 10(Suppl 1), 119125 (1984).
12.R. M. Macklis, T. Meier, and M. S. Weinhous, “Error rates in clinical radiotherapy,” J. Clin. Oncol. 16, 551556 (1998).
13.G. Huang, G. Medlam, J. Lee, S. Billingsley, J. P. Bissonnette, J. Ringash, G. Kane, and D. C. Hodgson, “Error in the delivery of radiation therapy: Results of a quality assurance review,” Int. J. Radiat. Oncol., Biol., Phys. 61, 15901595 (2005).
14.C. Szerlag, “Best practices,” ADVANCE 16, 8085 (2006).
15.A. L. Boyer and T. Schultheiss, “Effects of dosimetric and clinical uncertainty on complication-free local tumor control,” Radiother. Oncol. 11, 6571 (1988).
16.J. W. H. Leer, R. Corver, J. J. A. M Kraus, J. Ch. Togt, and O. J. S. Buruma, “A quality assurance system based on ISO standards: experience in a radiotherapy department,” Radiother. Oncol. 35, 7581 (1995).
17.K. Holli, P. Laippala, A. Ojala, and M. Pitkanen, “Quality control in health care: an experiment in radiotherapy planning for breast cancer patients after mastectomy,” Int. J. Radiat. Oncol., Biol., Phys. 44, 827833 (1999).
18.M. A. Pitkanen, K. A. Holli, A. T. Ojala, and P. Laippala, “Quality assurance in radiotherapy of breast cancer–variability in planning target volume delineation,” Acta Oncol. 40, 5055 (2001).
19.B. Tomadsen, S. W. Lin, P. Laemmrich, T. Waller, A. Cheng, B. Caldwell, R. Rankin, and J. Stitt, “Analysis of treatment delivery errors in brachytherapy using formal risk analysis techniques,” Int. J. Radiat. Oncol., Biol., Phys. 57, 14921508 (2003).
20.T. Pawlicki, M. Whitaker, and A. L. Boyer, “Statistical process control for radiotherapy quality assurance,” Med. Phys. 32, 27772786 (2005).
21.G. A. Patton, D. K. Gaffney, and J. H. Moeller, “Facilitation of radiotherapeutic error by computerized record and verify systems,” Int. J. Radiat. Oncol., Biol., Phys. 56, 5057 (2003).
22.W. E. Deming, The New Economics for Industry Government, Education, 2nd ed. (MIT, Cambridge, MA, 1993).
23.P. Scalliet, “Risk, society and system failure,” Radiother. Oncol. 80, 275281 (2006).
24.A. Niemierko, “Quality assurance and validation of individual IMRT treatment plans before delivery,” Med. Phys. 31, 421422 (2004).
25.G. S. Ibbott, A. Molineu, and D. S. Followill, “Independent evaluations of IMRT through the use of an anthropomorphic phantom,” Technol. Cancer Res. Treat. 5, 481487 (2006).
26.Abt Associates Inc., Washington DC, 2003, pp. 174.
27.ISO 9000 and Other Standards, American Society for Quality,, 8 January 2007.
28.R. Lupan, I. C. Bacivarof, A. Kobi, and C. Robledo, “A relationship between Six Sigma and ISO 9000:2000,” Qual. Eng. 17, 719725 (2005).
29.M. R. O’Leary, Lexikon, Joint Commission on Accreditation of Healthcare Organization (JACHO, Oakbrook Terrace, 1994).
30.R. G. Carey and R. C. Lloyd, Measuring Quality Improvement in Healthcare: A Guide to Statistical Process Control Applications (ASQ Quality, Milwaukee, WI, 2001).
31.W. H. Ettinger, “Six Sigma: adapting GE’s lessons to health care,” Trustee 54, 1015 (2001).
32.G. J. Kutcher, L. Coia, M. Gillin, W. F. Hanson, S. Leibel, R. J. Morton, J. R. Palta, J. A. Purdy, L. E. Reinstein, and G. K. Svensson, “Comprehensive QA for radiation oncology: report of AAPM Radiation Therapy Committee Task Group 40,” Med. Phys. 21, 581618 (1994).
33.B. Fraass, K. Doppke, M. Hunt, G. Kutcher, G. Starkschall, R. Stern, and J. Van Dyke, “American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: Quality assurance for clinical radiotherapy treatment planning,” Med. Phys. 25, 17731829 (1998).
34.D. Hutchison, “Chaos theory, complexity theory, and health care quality management,” Qual. Prog. November, 6972 (1994).
35.P. P. Harteloh and F. W. Verheggen, “Quality assurance in health care. From a traditional towards a modern approach,” Health Policy 27, 261270 (1994).
36.G. Laffel and D. Blumenthal, “The case for using industrial quality management science in health care organizations,” JAMA, J. Am. Med. Assoc. 262, 28692873 (1989).
37.G. Taguchi, Introduction to Quality Engineering (American Supplier Institute, Dearborn, MI, 1986).
38.O. Hupe and J. Brunzendorf, “A novel method of radiochromic film dosimetry using a color scanner,” Med. Phys. 33, 40854094 (2006).
39.A. L. McNiven, M. Mulligan, T. Kron, and J. J. Battista, “The response of prototype plane-parallel ionization chambers in small megavoltage x-ray fields,” Med. Phys. 33, 39974004 (2006).
40.A. S. Meigooni, S. B. Awan, and K. Dou, “Feasibility of calibrating elongated brachytherapy sources using a well-type ionization chamber,” Med. Phys. 33, 41844189 (2006).
41.A. Piermattei, A. Fidanzio, G. Stimato, L. Azario, L. Grimaldi, G. D’Onofrio, S. Cilla, M. Balducci, M. A. Gambacorta, N. Di Napoli, and N. Cellini, “In vivo dosimetry by an aSi-based EPID,” Med. Phys. 33, 44144422 (2006).
42.C. Talamonti, M. Casati, and M. Bucciolini, “Pretreatment verification of IMRT absolute dose distributions using a commercial a-Si EPID,” Med. Phys. 33, 43674378 (2006).
43.S. Yoo, G. Y. Kim, R. Hammoud, E. Elder, T. Pawlicki, H. Guan, T. Fox, G. Luxton, F. F. Yin, and P. Munro, “A quality assurance program for the on-board imager,” Med. Phys. 33, 44314447 (2006).
44.O. A. Zeidan, S. A. L. Stephenson, S. L. Meeks, T. H. Wagner, T. R. Willoughby, P. A. Kupelian, and K. M. Langen, “Characterization and use of EBT radiochromic film for IMRT dose verification,” Med. Phys. 33, 40644072 (2006).
45.D. Thwaites, “Quality assurance into the next century,” Radiother. Oncol. 54, viiix (2000).
46.J. E. Ibrahim, “Translating quality into research: Do we need more research into quality or should quality activities be conducted using the principles and methodological rigour of scientific research?,” J. Qual. Clin. Pract. 20, 6364 (2000).
47.H. Singh, L. A. Petersen, and E. J. Thomas, “Understanding diagnostic errors in medicine: a lesson from aviation,” Qual. Saf. Health. Care 15, 159164 (2006).
48.P. Dixon and B. O’Sullivan, “Radiotherapy quality assurance: time for everyone to take it seriously,” Eur. J. Cancer 39, 423429 (2003).
49.P. B. Boggs, “Peak expiratory flow rate control chart: a breakthrough in asthma care,” Ann. Allergy Asthma Immunol. 77, 429432 (1996).
50.T. Kehoe and L.-J. Rugg, “From technical quality assurance of radiotherapy to a comprehensive quality of service management system,” Radiother. Oncol. 51, 281290 (1999).
51.K. H. Yu, R. L. Nation, and M. J. Dooley, “Multiplicity of medication safety terms, definitions and functional meanings: when is enough enough?,” Qual. Saf. Health. Care 14, 358363 (2005).
52.P. Pronovost and R. Wachter, “Proposed standard for quality improvement research and publication: one step forward and two steps back,” Qual. Saf. Health. Care 15, 152153 (2006).
53.B. L. Sadler, “To the class of 2005: Will you be ready for the quality revolution?,” J. Qual. Pat. Saf. 32, 5455 (2006).
54.E. Davies and P. D. Cleary, “Hearing the patient’s voice? Factors affecting the use of patient survey data in quality improvement,” Qual. Saf. Health. Care 14, 428432 (2005).

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A modern approach to quality was developed in the United States at Bell Telephone Laboratories during the first part of the 20th century. Over the years, those quality techniques have been adopted and extended by almost every industry. Medicine in general and radiationoncology in particular have been slow to adopt modern quality techniques. This work contains a brief description of the history of research on quality that led to the development of organization-wide quality programs such as Six Sigma. The aim is to discuss the current approach to quality in radiationoncology as well as where quality should be in the future. A strategy is suggested with the goal to provide a threshold improvement in quality over the next 10 years.


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